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Reducing the incidence of induced abortion through family planning use can avert many associated problems: • 20 million unsafe abortions occur each year globally. • 70,000 women die from complications of unsafe abortion each year. • 1 in 8 pregnancy-related deaths are due to unsafe abortion. • Family planning could prevent 90% of maternal mortality associated with unsafe abortion. Factors contributing to repeat unsafe abortions • Lack of recognition of the problem of unsafe abortion and clients’ needs for family planning • Lack of family planning services for some groups, for example, adolescents • Family planning services not integrated with postabortion emergency services 19.9 Postabortion Counselling A woman who has had an abortion needs support. A woman who has faced the double risk of pregnancy and unsafe induced abortion especially needs help and support. Good counselling gives a postabortion client much needed support. In particular, the counsellor should: • Try to understand what the client has been through • Treat her with respect and avoid judgment and criticism • Ensure privacy and confidentiality • Ask if she wants someone she trusts to be present during counselling. Postabortion counselling messages A woman has important choices to make after receiving postabortion care. To make decisions about her health and fertility, she needs to know: • Fertility returns quickly—within 11 days after a first-trimester abortion or miscarriage and within 4 weeks after a second-trimester abortion or miscarriage. Therefore, she needs protection from pregnancy almost immediately. • She can choose from among many different family planning methods that can be started at once (see When to Start Contraceptive Methods, Section 19.10). Methods that women should not use immediately after giving birth pose no special risks after abortion. • She can wait before choosing a contraceptive method for ongoing use, but she should consider using a backup method in the meantime if she has sex. If a woman decides not to use contraceptives at this time, providers can offer information on available methods and where to obtain them. Also, providers can offer condoms, oral contraceptives, or emergency contraceptive pills for women to take home and use later. • To avoid infection, she should not have sex until bleeding stops—about 5 to 7 days. If being treated for infection or vaginal or cervical injury, she should wait to have sex again until she has fully healed. • She should wait at least 6 months before trying to become pregnant. Waiting at least 6 months reduces the chances of low birth weight, premature birth, and maternal anaemia. (For more information about the benefits of healthy spacing of pregnancies after abortion or miscarriage, see Unit 6: Healthy Timing and Spacing of Pregnancy.) 426 Preservice Education Family Planning Reference Guide
A woman receiving postabortion care may need other reproductive health services. In particular, a provider can help her consider if she might have been exposed to a sexually transmitted infection. 19.10 When to Start Contraceptive Methods after Abortion Can be started immediately • Combined oral contraceptives • Progestin-only pills • Progestin-only injectables • Contraceptive implants • Male and female condoms Can be started once infection is ruled out or resolved • IUCDs • Female sterilisation • Fertility awareness methods Can be started once any injury to the genital tract has healed • IUCDs • Female sterilisation • Fertility awareness methods Special considerations • IUCD insertion immediately after a second-trimester abortion requires a specifically trained provider. • Female sterilisation must be decided upon in advance, and not while a woman is sedated, under stress or in pain. Counsel carefully and be sure to mention available reversible methods as another option. • Fertility awareness methods: A woman can start symptoms-based methods like the TwoDay Method once she has no infection-related secretions or bleeding due to injury to the genital tract. She can start calendar-based methods like the Standard Days Method with her next monthly bleeding, if she does not have bleeding due to injury to the genital tract. Unit 19: Postpartum and Postabortion Family Planning 427
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